Costs and Outcomes of HIV/AIDS Treatment and PMTCT in Zambia

Project Description

Large-scale provision of antiretroviral therapy for HIV/AIDS began in Zambia in 2004. By the end of 2009, some 250,000 adults in Zambia had initiated ART. In 2007, the CGHD began collaborating with the Zambian Ministry of Health to estimate the costs of providing treatment to adults and children at different kinds of treatment facilities and in different settings around the country. By 2010, we had collected and analyzed patient cohort data that allowed us to evaluate treatment costs and outcomes at nearly a dozen sites.

Like many other resource-constrained countries, Zambia originally chose to include the drug stavudine (d4T) in its first-line ART regimen. d4T was effective, widely available, and much less expensive than the alternatives available at the time. By 2006, however, evidence had accumulated that d4T caused widespread side effects, and the World Health Organization began encouraging countries to consider substituting it with another drug. In mid-2007, Zambia revised its national treatment guidelines to include tenofovir (TDF) in place of d4T. TDF, a newer drug, has fewer side effects than d4T, but it was, and remains, much more expensive.

Because the CGHD’s study of adult treatment costs was already under way when the new guidelines took effect, we were well placed to help the Ministry and others understand the economic implications of the drug change. After estimating treatment costs at three different sites for patients who initiated therapy on d4T in 2006, we returned to the same sites in 2008 to select new patient samples and look at costs after the switch to TDF.

On average, the annual cost per patient treated with a tenofovir-based regimen—including lab tests, outpatient visits, and fixed costs as well as drugs—was 79% more than the annual average cost for a patient on a regimen containing d4T. Newly negotiated lower prices for ARVs, including TDF, promise to mitigate some of the impact of this cost increase in the coming years. Even with these price reductions, however, treatment with TDF will almost certainly remain a more expensive choice. It may force Zambia to make a difficult tradeoff between the quality of treatment offered and the total number of patients it can afford.

Results for pediatric treatment sites and analyses of the economic consequences of other guideline changes will become available over the coming months. In addition, work is beginning on the cost-effectiveness of alternative drug regimens and delivery approaches for the prevention of mother-to-child transmission of HIV.

Project Details

Principal Investigator Bruce Larson
Boston University Co-Investigators Gesine Meyer-RathCallie Scott
Country(ies) Zambia
Dates of Research 2007–current